A Traitlike Dimension of Subjective Memory Concern Over 30 Years Among Adult Male Twins
Authors: Tyler R. Bell, Asad Beck, Nathan A. Gillespie, Chandra A. Reynolds, Jeremy A. Elman, McKenna E. Williams, Daniel E. Gustavson, Michael J. Lyons, Michael C. Neale, William S. Kremen, Carol E. Franz
Journal: JAMA Psychiatry (2023)

Importance Subjective memory concern has long been considered a state-related indicator of impending cognitive decline or dementia. The possibility that subjective memory concern may itself be a heritable trait is largely ignored, yet such an association would substantially confound its use in clinical or research settings. Objective To assess the heritability and traitlike dimensions of subjective memory concern and its clinical correlates. Design, Setting, and Participants This longitudinal twin cohort study was conducted from 1967 to 2019 among male adults with a mean (SD) age of 37.75 (2.52) years to follow-up at mean ages of 56.15 (2.72), 61.50 (2.43), and 67.35 (2.57) years (hereafter, 38, 56, 62, and 67 years, respectively) in the Vietnam Era Twin Study of Aging. The study included a national community-dwelling sample with health, education, and lifestyle characteristics comparable to a general sample of US men in this age cohort. Participants were monozygotic and dizygotic twins randomly recruited from the Vietnam Era Twin Registry. Data were analyzed from May 2021 to December 2022. Main Outcomes and Measures Measures included subjective memory concern at 4 time points; objective memory, depressive symptoms, and anxiety at the last 3 time points; negative emotionality (trait neuroticism) at age 56 years; polygenic risk scores (PRSs) for neuroticism, depression, and Alzheimer disease; APOE genotype; and parental history of dementia. Primary outcomes were heritability and correlations between subjective memory concern and other measures. Results The sample included 1555 male adults examined at age 38 years, 520 at age 56 years (due to late introduction of subjective memory concern questions), 1199 at age 62 years, and 1192 at age 67 years. Phenotypically, subjective memory concerns were relatively stable over time. At age 56 years, subjective memory concern had larger correlations with depressive symptoms ( r , 0.32; 95% CI, 0.21 to 0.42), anxiety ( r , 0.36; 95% CI, 0.18 to 0.51), and neuroticism ( r , 0.34; 95% CI, 0.26 to 0.41) than with objective memory ( r , −0.24; 95% CI, −0.33 to −0.13). Phenotypic results were similar at ages 62 and 67 years. A best-fitting autoregressive twin model indicated that genetic influences on subjective memory concern accumulated and persisted over time ( h 2 = 0.26-0.34 from age 38-67 years). At age 56 years, genetic influences for subjective memory concern were moderately correlated with genetic influences for anxiety ( r , 0.36; 95% CI, 0.18 to 0.51), negative emotionality ( r , 0.51; 95% CI, 0.44-0.57), and depressive symptoms ( r , 0.20; 95% CI, 0.10 to 0.29) as well as objective memory ( r , −0.22; 95% CI, −0.30 to −0.14). Similar genetic correlations were seen at ages 62 and 67 years. The neuroticism PRS was associated with subjective memory concern at age 38 years ( r , 0.10; 95% CI, 0.03. to 0.18) and age 67 years ( r , 0.09; 95% CI, 0.01 to 0.16). Subjective memory concern was not associated with any Alzheimer disease risk measures. Conclusions and Relevance This cohort study found stable genetic influences underlying subjective memory concern dating back to age 38 years. Subjective memory concern had larger correlations with affect-related measures than with memory-related measures. Improving the utility of subjective memory concern as an indicator of impending cognitive decline and dementia may depend on isolating its statelike component from its traitlike component.